Predicting tumour motion during the whole radiotherapy treatment: a systematic approach for thoracic and abdominal lesions based on real time MR

Cusumano, D.; Dhont, Jennifer; Boldrini, Luca; Chiloiro, G.; Teodoli, S.; Massaccesi, Mariangela; Fionda, Bruno; Cellini, Francesco; Azario, L.; Vandemeulebroucke, Jef; Spirito, Marco De; Valentini, Vincenzo; Verellen, Dirk

doi:10.1016/j.radonc.2018.07.025

Cited by 60 publications

(49 citation statements)

References 41 publications

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“…The acquisition time of the 4DMRI was limited to 80 s due to technical reasons, which is shorter than 2D cine-MR imaging studies reported in literature. [33][34][35] However, the proposed method could be easily extended to longer acquisition times in the future to improve statistics to assure that the representative target motion of the day is captured. 22 The DIR steps introduce uncertainties that are difficult to quantify but that are expected to be counterbalanced by the higher representativity of the target motion description compared to a 4D-CT-based ITV definition.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Several studies have investigated intrafractional and interfractional changes with 2D cine-MRI. 6,[30][31][32][33][34][35] Cai et al 36 showed that the characterization of lung tumor motion with temporally resolved MRI is more representative than with 4D-CT, mainly due to improved statistics through longer acquisition times. 22 Hence, temporally resolved MRI can help to refine the ITV definition for treatment planning.…”

Section: Introductionmentioning

confidence: 99%

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Real‐time 4DMRI‐based internal target volume definition for moving lung tumors

et al. 2020

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PTVs were smaller than the ITV-based PTVs. While the SE was high for patients with small breathing pattern variations, changes of the median breathing amplitudes in different imaging sessions led to inferior SE values for the mid-ventilation PTV for one patient. In contrast, PTV 5% r and PTV 10% r showed higher SE values with a higher robustness against interfractional changes, at the cost of larger target volumes. Conclusions:The results indicate that rt-4DMRI could be valuable for the definition of target volumes based on the GTV POP to achieve a higher robustness against interfractional changes than feasible with today's 4D-CT-based target definition concepts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real‐time 4DMRI‐based internal target volume definition for moving lung tumors

et al. 2020

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“…[1][2][3] To ensure an adequate coverage of the tumor with the intended dose, a margin for intra/inter-fraction patient changes (internal margin) and for setup uncertainties (setup margin) is added around the clinical target volume to obtain the planning target volume (PTV). [1][2][3] To ensure an adequate coverage of the tumor with the intended dose, a margin for intra/inter-fraction patient changes (internal margin) and for setup uncertainties (setup margin) is added around the clinical target volume to obtain the planning target volume (PTV).…”

Section: Introductionmentioning

confidence: 99%

“…Particularly, breathing-induced tumor motion up to 2 cm is common in lung and upper abdomen and even larger excursions can occur. [1][2][3] To ensure an adequate coverage of the tumor with the intended dose, a margin for intra/inter-fraction patient changes (internal margin) and for setup uncertainties (setup margin) is added around the clinical target volume to obtain the planning target volume (PTV).…”

Section: Introductionmentioning

confidence: 99%

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A new frontier of image guidance: Organs at risk avoidance with MRI‐guided respiratory‐gated intensity modulated radiotherapy: Technical note and report of a case

Massaccesi

Cusumano

Boldrini

et al. 2019

J Applied Clin Med Phys

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The case of a 50‐year‐old man affected by a rhabdomiosarcoma metastatic lesion in the left flank Is reported. The patient was addressed to 50.4 Gy radiotherapy with concomitant chemotherapy in order to locally control the lesion. A Tri‐60‐Co magnetic resonance hybrid radiotherapy unit was used for treatment delivery and a respiratory gating protocol was applied for the different breathing phases (Free Breathing, Deep Inspiration Breath Hold and Final Expiration Breath Hold). Three intensity modulated radiation therapy (IMRT) plans were calculated and Final Expiration Breath Hold plan was finally selected due to the absence of PTV coverage differences and better organs at risk sparing (i.e. kidneys). This case report suggests that organs at risk avoidance with MRI‐guided respiratory‐gated Radiotherapy is feasible and particularly advantageous whenever sparing the organs at risk is of utmost dosimetric or clinical importance.

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Dose deviations induced by respiratory motion for radiotherapy of lung tumors: Impact of CT reconstruction, plan complexity, and fraction size

Sande

Roa

Hellebust

2020

J Applied Clin Med Phys

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A thorax phantom was used to assess radiotherapy dose deviations induced by respiratory motion of the target volume. Both intensity modulated and static, non-modulated treatment plans were planned on CT scans of the phantom. The plans were optimized using various CT reconstructions, to investigate whether they had an impact on robustness to target motion during delivery. During irradiation, the target was programmed to simulate respiration-induced motion of a lung tumor, using both patient-specific and sinusoidal motion patterns in three dimensions. Dose was measured in the center of the target using an ion chamber. Differences between reference measurements with a stationary target and dynamic measurements were assessed. Possible correlations between plan complexity metrics and measured dose deviations were investigated. The maximum observed motion-induced dose differences were 7.8% and 4.5% for single 2 Gy and 15 Gy fractions, respectively. The measurements performed with the largest target motion amplitude in the superiorinferior direction yielded the largest dosimetric deviations. For 2 Gy fractionation schemes, the summed dose deviation after 33 fractions is likely to be less than 2%.Measured motion-induced dose deviations were significantly larger for one CT reconstruction compared to all the others. Static, non-modulated plans showed superior robustness to target motion during delivery. Moderate correlations between the modulation complexity score applied to VMAT (MCSv) and measured dose deviations were found for 15 Gy SBRT treatment plans. Correlations between other plan complexity metrics and measured dose deviations were not found. K E Y W O R D S complexity, interplay, lung, radiotherapy, SBRT, VMAT

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Predicting tumour motion during the whole radiotherapy treatment: a systematic approach for thoracic and abdominal lesions based on real time MR

Cited by 60 publications

References 41 publications

Real‐time 4DMRI‐based internal target volume definition for moving lung tumors

Real‐time 4DMRI‐based internal target volume definition for moving lung tumors

A new frontier of image guidance: Organs at risk avoidance with MRI‐guided respiratory‐gated intensity modulated radiotherapy: Technical note and report of a case

Dose deviations induced by respiratory motion for radiotherapy of lung tumors: Impact of CT reconstruction, plan complexity, and fraction size

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